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Published in: BMC Public Health 1/2022

Open Access 01-12-2022 | Research

Perspectives on cancer screening participation in a highly urbanized region: a Q-methodology study in The Hague, the Netherlands

Authors: Thomas H. G. Bongaerts, Frederike L. Büchner, Matty R. Crone, Job van Exel, Onno R. Guicherit, Mattijs E. Numans, Vera Nierkens

Published in: BMC Public Health | Issue 1/2022

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Abstract

Background

The Netherlands hosts, as many other European countries, three population-based cancer screening programmes (CSPs). The overall uptake among these CSPs is high, but has decreased over recent years. Especially in highly urbanized regions the uptake rates tend to fall below the minimal effective rate of 70% set by the World Health Organization. Understanding the reasons underlying the decision of citizens to partake in a CPS are essential in order to optimize the current screening participation rates. The aim of this study was to explore the various perspectives concerning cancer screening among inhabitants of The Hague, a highly urbanized region of the Netherlands.

Methods

A Q-methodology study was conducted to provide insight in the prevailing perspectives on partaking in CSPs. All respondents were inhabitants of the city of The Hague, the Netherlands. In an online application they ranked a set of 31 statements, based on the current available literature and clustered by the Integrated Change model, into a 9-column forced ranking grid according to level of agreement, followed by a short survey. Respondents were asked to participate in a subsequent interview to explain their ranking. By-person factor analysis was used to identify distinct perspectives, which were interpreted using data from the rankings and interviews.

Results

Three distinct perspectives were identified: 1). Positive about participation, 2). Thoughtful about participation, and 3). Fear drives participation. These perspectives provide insight into how potential respondents, living in an urbanized region in the Netherlands, decide upon partaking in CSPs.

Conclusions

Since CSPs will only be effective when participation rates are sufficiently high, it is essential to have insight into the different perspectives among potential respondents concerning partaking in a CSP. This study adds new insights concerning these perspectives and suggests several ideas for future optimization of the CSPs.
Literature
1.
go back to reference European Commission, Directorate-General for Research and Innovation, Group of Chief Scientific Advisors. Cancer screening in the European Union. 2022. European Commission, Directorate-General for Research and Innovation, Group of Chief Scientific Advisors. Cancer screening in the European Union. 2022.
2.
go back to reference van Ballegooijen M, van den Akker-van ME, Patnick J, Lynge E, Arbyn M, Anttila A, et al. Overview of important cervical cancer screening process values in European Union (EU) countries, and tentative predictions of the corresponding effectiveness and cost-effectiveness. Eur J Cancer. 2000;36(17):2177–88.PubMedCrossRef van Ballegooijen M, van den Akker-van ME, Patnick J, Lynge E, Arbyn M, Anttila A, et al. Overview of important cervical cancer screening process values in European Union (EU) countries, and tentative predictions of the corresponding effectiveness and cost-effectiveness. Eur J Cancer. 2000;36(17):2177–88.PubMedCrossRef
3.
go back to reference van Ballegooijen M, Hermens R. Cervical cancer screening in The Netherlands. Eur J Cancer. 2000;36(17):2244–6.PubMedCrossRef van Ballegooijen M, Hermens R. Cervical cancer screening in The Netherlands. Eur J Cancer. 2000;36(17):2244–6.PubMedCrossRef
4.
go back to reference European Colorectal Cancer Screening Guidelines Working Group, von Karsa L, Patnick J, Segnan N, Atkin W, Halloran S, et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication. Endoscopy. 2013;45(1):51–9. European Colorectal Cancer Screening Guidelines Working Group, von Karsa L, Patnick J, Segnan N, Atkin W, Halloran S, et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication. Endoscopy. 2013;45(1):51–9.
5.
go back to reference Verbeek ALM, Broeders MJM. Evaluation of The Netherlands breast cancer screening programme. Ann Oncol. 2003;14(8):1203–5.PubMedCrossRef Verbeek ALM, Broeders MJM. Evaluation of The Netherlands breast cancer screening programme. Ann Oncol. 2003;14(8):1203–5.PubMedCrossRef
10.
go back to reference Young B, Robb KA. Understanding patient factors to increase uptake of cancer screening: a review. Future Oncol. 2021;17(28):3757–75.PubMedCrossRef Young B, Robb KA. Understanding patient factors to increase uptake of cancer screening: a review. Future Oncol. 2021;17(28):3757–75.PubMedCrossRef
11.
go back to reference Lynge E, Törnberg S, von Karsa L, Segnan N, van Delden JJ. Determinants of successful implementation of population-based cancer screening programmes. Eur J Cancer. 2012;48(5):743–8.PubMedCrossRef Lynge E, Törnberg S, von Karsa L, Segnan N, van Delden JJ. Determinants of successful implementation of population-based cancer screening programmes. Eur J Cancer. 2012;48(5):743–8.PubMedCrossRef
12.
go back to reference World Health Organization. Cancer control: Early detection. WHO guide for effective programmes. Geneva: 2007. World Health Organization. Cancer control: Early detection. WHO guide for effective programmes. Geneva: 2007.
13.
go back to reference World Health Organization. National cancer control programmes: policies and managerial guidelines. Geneva: World Health Organization; 2002. World Health Organization. National cancer control programmes: policies and managerial guidelines. Geneva: World Health Organization; 2002.
14.
go back to reference World Health Organization. Guide to cancer early diagnosis. 2017. World Health Organization. Guide to cancer early diagnosis. 2017.
16.
go back to reference Bongaerts THG, Büchner FL, Middelkoop BJ, Guicherit OR, Numans ME. Determinants of (non-) attendance at the Dutch cancer screening programmes: A systematic review. J Med Screen. 2020;27(3):121–9.PubMedCrossRef Bongaerts THG, Büchner FL, Middelkoop BJ, Guicherit OR, Numans ME. Determinants of (non-) attendance at the Dutch cancer screening programmes: A systematic review. J Med Screen. 2020;27(3):121–9.PubMedCrossRef
17.
go back to reference Myers L, Goodwin B, Ralph N, March S. A health action process approach for developing invitee endorsed interventions to increase mail‐out bowel cancer screening. Applied Psychology: Health and Well‐Being. 2022. https://doi.org/10.1111/aphw.12346. Myers L, Goodwin B, Ralph N, March S. A health action process approach for developing invitee endorsed interventions to increase mail‐out bowel cancer screening. Applied Psychology: Health and Well‐Being. 2022. https://​doi.​org/​10.​1111/​aphw.​12346.
19.
go back to reference Tacken MA, Braspenning JC, Hermens RP, Spreeuwenberg PM, Van Den Hoogen HJ, De Bakker DH, et al. Uptake of cervical cancer screening in The Netherlands is mainly influenced by women’s beliefs about the screening and by the inviting organization. Eur J Public Health. 2007;17(2):178–85.PubMedCrossRef Tacken MA, Braspenning JC, Hermens RP, Spreeuwenberg PM, Van Den Hoogen HJ, De Bakker DH, et al. Uptake of cervical cancer screening in The Netherlands is mainly influenced by women’s beliefs about the screening and by the inviting organization. Eur J Public Health. 2007;17(2):178–85.PubMedCrossRef
20.
go back to reference Forss A, Tishelman C, Widmark C, Lundgren EL, Sachs L, Törnberg S. ‘I got a letter…’A qualitative study of women’s reasoning about attendance in a cervical cancer screening programme in urban Sweden. Psychooncology. 2001;10(1):76–87.PubMedCrossRef Forss A, Tishelman C, Widmark C, Lundgren EL, Sachs L, Törnberg S. ‘I got a letter…’A qualitative study of women’s reasoning about attendance in a cervical cancer screening programme in urban Sweden. Psychooncology. 2001;10(1):76–87.PubMedCrossRef
21.
24.
go back to reference Patty NJ, Van Dijk HM, Wallenburg I, Bal R, Helmerhorst TJ, Van Exel J, et al. To vaccinate or not to vaccinate? Perspectives on HPV vaccination among girls, boys, and parents in the Netherlands: a Q-methodological study. BMC Public Health. 2017;17(1):1–12.CrossRef Patty NJ, Van Dijk HM, Wallenburg I, Bal R, Helmerhorst TJ, Van Exel J, et al. To vaccinate or not to vaccinate? Perspectives on HPV vaccination among girls, boys, and parents in the Netherlands: a Q-methodological study. BMC Public Health. 2017;17(1):1–12.CrossRef
25.
go back to reference Rotteveel A, Reckers-Droog V, Lambooij M, De Wit G, Van Exel N. Societal views in the Netherlands on active disinvestment of publicly funded healthcare interventions. Soc Sci Med. 2021;272:113708.PubMedCrossRef Rotteveel A, Reckers-Droog V, Lambooij M, De Wit G, Van Exel N. Societal views in the Netherlands on active disinvestment of publicly funded healthcare interventions. Soc Sci Med. 2021;272:113708.PubMedCrossRef
28.
go back to reference Weinstein ND, Lyon JE, Sandman PM, Cuite CL. Experimental evidence for stages of health behavior change: the precaution adoption process model applied to home radon testing. Health Psychol. 1998;17(5):445.PubMedCrossRef Weinstein ND, Lyon JE, Sandman PM, Cuite CL. Experimental evidence for stages of health behavior change: the precaution adoption process model applied to home radon testing. Health Psychol. 1998;17(5):445.PubMedCrossRef
29.
go back to reference Rogers RW. A protection motivation theory of fear appeals and attitude change1. J Psychol. 1975;91(1):93–114.PubMedCrossRef Rogers RW. A protection motivation theory of fear appeals and attitude change1. J Psychol. 1975;91(1):93–114.PubMedCrossRef
30.
31.
go back to reference Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211.CrossRef Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211.CrossRef
32.
go back to reference De Vries H, Mesters I, Van de Steeg H, Honing C. The general public’s information needs and perceptions regarding hereditary cancer: an application of the Integrated Change Model. Patient Educ Couns. 2005;56(2):154–65.PubMedCrossRef De Vries H, Mesters I, Van de Steeg H, Honing C. The general public’s information needs and perceptions regarding hereditary cancer: an application of the Integrated Change Model. Patient Educ Couns. 2005;56(2):154–65.PubMedCrossRef
33.
go back to reference Groenenberg I, Crone MR, van Dijk S, Gebhardt WA, Meftah JB, Middelkoop BJ, et al. ‘Check it out!’Decision-making of vulnerable groups about participation in a two-stage cardiometabolic health check: a qualitative study. Patient Educ Couns. 2015;98(2):234–44.PubMedCrossRef Groenenberg I, Crone MR, van Dijk S, Gebhardt WA, Meftah JB, Middelkoop BJ, et al. ‘Check it out!’Decision-making of vulnerable groups about participation in a two-stage cardiometabolic health check: a qualitative study. Patient Educ Couns. 2015;98(2):234–44.PubMedCrossRef
34.
go back to reference Nierkens V, Stronks K, de Vries H. Attitudes, social influences and self-efficacy expectations across different motivational stages among immigrant smokers: Replication of the∅ pattern. Prev Med. 2006;43(4):306–11.PubMedCrossRef Nierkens V, Stronks K, de Vries H. Attitudes, social influences and self-efficacy expectations across different motivational stages among immigrant smokers: Replication of the∅ pattern. Prev Med. 2006;43(4):306–11.PubMedCrossRef
43.
go back to reference Cooke R, French DP. How well do the theory of reasoned action and theory of planned behaviour predict intentions and attendance at screening programmes? Psychol health. 2008;23(7):745–65.PubMedCrossRef Cooke R, French DP. How well do the theory of reasoned action and theory of planned behaviour predict intentions and attendance at screening programmes? Psychol health. 2008;23(7):745–65.PubMedCrossRef
44.
go back to reference Cullati S, Charvet-Bérard AI, Perneger TV. Cancer screening in a middle-aged general population: factors associated with practices and attitudes. BMC Public Health. 2009;9(1):1–11.CrossRef Cullati S, Charvet-Bérard AI, Perneger TV. Cancer screening in a middle-aged general population: factors associated with practices and attitudes. BMC Public Health. 2009;9(1):1–11.CrossRef
45.
go back to reference Douma LN, Uiters E, Timmermans DR. Why are the public so positive about colorectal cancer screening? BMC Public Health. 2018;18(1):1–9.CrossRef Douma LN, Uiters E, Timmermans DR. Why are the public so positive about colorectal cancer screening? BMC Public Health. 2018;18(1):1–9.CrossRef
46.
go back to reference Savage SA, Clarke VA. Older women’s illness representations of cancer: a qualitative study. Health Educ Res. 1998;13(4):529–44.PubMedCrossRef Savage SA, Clarke VA. Older women’s illness representations of cancer: a qualitative study. Health Educ Res. 1998;13(4):529–44.PubMedCrossRef
47.
go back to reference Douma LN, Uiters E, Timmermans DR. The Dutch public are positive about the colorectal cancer-screening programme, but is this a well-informed opinion? BMC Public Health. 2016;16(1):1–12.CrossRef Douma LN, Uiters E, Timmermans DR. The Dutch public are positive about the colorectal cancer-screening programme, but is this a well-informed opinion? BMC Public Health. 2016;16(1):1–12.CrossRef
49.
go back to reference Gigerenzer G, Mata J, Frank R. Public knowledge of benefits of breast and prostate cancer screening in Europe. J Natl Cancer Inst. 2009;101(17):1216–20.PubMedPubMedCentralCrossRef Gigerenzer G, Mata J, Frank R. Public knowledge of benefits of breast and prostate cancer screening in Europe. J Natl Cancer Inst. 2009;101(17):1216–20.PubMedPubMedCentralCrossRef
50.
go back to reference Dubayova T, van Dijk JP, Nagyova I, Rosenberger J, Havlikova E, Gdovinova Z, et al. The impact of the intensity of fear on patient’s delay regarding health care seeking behavior: a systematic review. Int J Public Health. 2010;55(5):459–68.PubMedCrossRef Dubayova T, van Dijk JP, Nagyova I, Rosenberger J, Havlikova E, Gdovinova Z, et al. The impact of the intensity of fear on patient’s delay regarding health care seeking behavior: a systematic review. Int J Public Health. 2010;55(5):459–68.PubMedCrossRef
51.
go back to reference McCaul KD, Schroeder DM, Reid PA. Breast cancer worry and screening: some prospective data. Health Psychol. 1996;15(6):430.PubMedCrossRef McCaul KD, Schroeder DM, Reid PA. Breast cancer worry and screening: some prospective data. Health Psychol. 1996;15(6):430.PubMedCrossRef
52.
go back to reference Vrinten C, Waller J, von Wagner C, Wardle J. Cancer fear: facilitator and deterrent to participation in colorectal cancer screening. Cancer Epidemiol Prev Biomarkers. 2015;24(2):400–5.CrossRef Vrinten C, Waller J, von Wagner C, Wardle J. Cancer fear: facilitator and deterrent to participation in colorectal cancer screening. Cancer Epidemiol Prev Biomarkers. 2015;24(2):400–5.CrossRef
53.
go back to reference Vernon SW. Risk perception and risk communication for cancer screening behaviors: a review. JNCI Monographs. 1999;1999(25):101–19.CrossRef Vernon SW. Risk perception and risk communication for cancer screening behaviors: a review. JNCI Monographs. 1999;1999(25):101–19.CrossRef
54.
go back to reference Atkinson TM, Salz T, Touza KK, Li Y, Hay JL. Does colorectal cancer risk perception predict screening behavior? A systematic review and meta-analysis. J Behav Med. 2015;38(6):837–50.PubMedPubMedCentralCrossRef Atkinson TM, Salz T, Touza KK, Li Y, Hay JL. Does colorectal cancer risk perception predict screening behavior? A systematic review and meta-analysis. J Behav Med. 2015;38(6):837–50.PubMedPubMedCentralCrossRef
55.
go back to reference Chan CW, Yang SB, Gu C, Wang X, Tao L. Perception of cervical cancer risk and screening behavior: a literature review. Int J Nurs Knowl. 2015;26(1):2–18.PubMedCrossRef Chan CW, Yang SB, Gu C, Wang X, Tao L. Perception of cervical cancer risk and screening behavior: a literature review. Int J Nurs Knowl. 2015;26(1):2–18.PubMedCrossRef
56.
go back to reference Goodwin BC, Myers L, Ireland MJ, March S, Ralph N, Dunn J, et al. Barriers to home bowel cancer screening. Psychooncology. 2021;30(10):1756–64.PubMedCrossRef Goodwin BC, Myers L, Ireland MJ, March S, Ralph N, Dunn J, et al. Barriers to home bowel cancer screening. Psychooncology. 2021;30(10):1756–64.PubMedCrossRef
57.
go back to reference De Nooijer D, De Waart F, Van Leeuwen A, Spijker W. Participation in the Dutch national screening programme for uterine cervic cancer higher after invitation by a general practitioner, especially in groups with a traditional low level of attendance. Ned Tijdschr Geneeskd. 2005;149(42):2339–43.PubMed De Nooijer D, De Waart F, Van Leeuwen A, Spijker W. Participation in the Dutch national screening programme for uterine cervic cancer higher after invitation by a general practitioner, especially in groups with a traditional low level of attendance. Ned Tijdschr Geneeskd. 2005;149(42):2339–43.PubMed
58.
go back to reference Hermens RP, Tacken MA, Hulscher ME, Braspenning JC, Grol RP. Attendance to cervical cancer screening in family practices in The Netherlands. Prev Med. 2000;30(1):35–42.PubMedCrossRef Hermens RP, Tacken MA, Hulscher ME, Braspenning JC, Grol RP. Attendance to cervical cancer screening in family practices in The Netherlands. Prev Med. 2000;30(1):35–42.PubMedCrossRef
59.
go back to reference Spadea T, Bellini S, Kunst A, Stirbu I, Costa G. The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: a review. Prev Med. 2010;50(4):159–64.PubMedCrossRef Spadea T, Bellini S, Kunst A, Stirbu I, Costa G. The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: a review. Prev Med. 2010;50(4):159–64.PubMedCrossRef
60.
go back to reference Reath J, Carey M. Breast and cervical cancer in Indigenous women: overcoming barriers to early detection. Australian family physician. 2008;37(3):178-82. Reath J, Carey M. Breast and cervical cancer in Indigenous women: overcoming barriers to early detection. Australian family physician. 2008;37(3):178-82.
61.
go back to reference Watts S, Stenner P. Doing Q methodology: theory, method and interpretation. Qual Res Psychol. 2005;2(1):67–91.CrossRef Watts S, Stenner P. Doing Q methodology: theory, method and interpretation. Qual Res Psychol. 2005;2(1):67–91.CrossRef
62.
go back to reference Baker RM, Van Exel J, Mason H, Stricklin M. Connecting Q & surveys: three methods to explore factor membership in large samples Operant Subjectivity. Int J Q Methodol. 2010;34(1):38–58. Baker RM, Van Exel J, Mason H, Stricklin M. Connecting Q & surveys: three methods to explore factor membership in large samples Operant Subjectivity. Int J Q Methodol. 2010;34(1):38–58.
63.
go back to reference Danielson S, Tuler SP, Santos SL, Webler T, Chess C. Three tools for evaluating participation: Focus groups, Q method, and surveys. Environ Pract. 2012;14(2):101–9.CrossRef Danielson S, Tuler SP, Santos SL, Webler T, Chess C. Three tools for evaluating participation: Focus groups, Q method, and surveys. Environ Pract. 2012;14(2):101–9.CrossRef
Metadata
Title
Perspectives on cancer screening participation in a highly urbanized region: a Q-methodology study in The Hague, the Netherlands
Authors
Thomas H. G. Bongaerts
Frederike L. Büchner
Matty R. Crone
Job van Exel
Onno R. Guicherit
Mattijs E. Numans
Vera Nierkens
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-022-14312-4

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